Behavioral health integration (BHI) broadly encompasses efforts to integrate behavioral health and primary care across multiple settings and is commonly viewed as part of a broader behavioral health continuum. These efforts are historically constrained by a fragmented and misaligned quality measurement landscape that can limit effectiveness and efficiency of integration initiatives. When used strategically, quality measurement can accelerate integration, reinforce evidence-based practices, and support value-based payment strategies.
In November 2025, NASHP convened an expert roundtable and its Behavioral Health Integration Workgroup to explore how states are selecting, aligning, and applying quality measures to advance integrated behavioral health care and strengthen accountability across delivery and payment systems.
Key Takeaways
- Shift toward outcome measures. While process measures are important for tracking implementation and utilization, systems can focus on increased and consistent use of outcome measures, including patient-reported measures, functional, recovery-oriented, and person-centered metrics. States can prioritize common, vetted, outcomes-based measurement in delivery and payment approaches.
- Core sets are converging on outcomes-based, lower burden approaches. Expert-consensus, federal, and state efforts are moving in a common direction on behavioral health measures, opening doors for greater cross-payer alignment and measurement-based care. In that effort, states can focus on core measures for common conditions that are evidence-based, meaningful, and low burden.
- Alignment delivers value. Coordinating measures across public and private payers can reduce provider burden, encourage adoption of evidence-based practices, facilitate quality improvement efforts, and support value-based payment.
- Data drives action. Timely, reliable claims and clinical- and patient-reported data make measures more meaningful and actionable. States can focus on strengthening data alignment and interoperability to support timely analysis, integrated care delivery, and aligned payment strategies.
From Process to Outcomes: Finding the Right Balance
Participants agreed that many measures used in BHI remain heavily focused on process. These measures, often drawn from established core measure sets, play an important role in early implementation by tracking engagement, infrastructure development, and workflow standardization. As a result, process measures continue to dominate quality reporting and payment programs.
States are looking for a more balanced approach. Participants discussed how different measures support integrated behavioral health goals over time, in different settings, and for different populations, including:
- Process measures to track whether core activities happen — screening rates, follow-up completion, and care plan documentation.
- Outcome measures to assess clinical improvement — symptom reduction, treatment response, and remission rates.
- Functional and person-centered measures to capture real-world impact — activities of daily living, employment, housing stability, quality of life, achievement of individual goals.
States face a crowded and overlapping measurement landscape spanning Medicaid, federal grant programs, managed care requirements, Medicare, and commercial payers. Participants emphasized the need to streamline existing measure sets and prioritize a smaller number of meaningful outcomes and functional measures. This aligns with broader efforts to advance measurement-informed care in outpatient behavioral health (see Advancing Measurement-Informed Care in Outpatient Community Behavioral Health), with a focus on cross-cutting outcomes that are feasible to measure, track, and link to real improvements in care. This approach can reduce administrative burden, strengthen accountability, and better support value-based payment in integrated behavioral health care.
Commonly Referenced Measurement Sets
As states advance BHI, these measurement sets illustrate areas of emerging alignment across state and federal programs around shared expectations for quality, outcomes, and accountability.
CMS Medicaid Core Sets (Adult and Child) – Widely used baseline for behavioral health measures in Medicaid, including screening, follow-up, and treatment engagement.
- HEDIS® (NCQA) – Commonly used in Medicaid managed care and commercial plans; includes process measures and a growing number of outcome measures related to mental health and substance use.
- SAMHSA Certified Community Behavioral Health Clinic (CCBHC) Quality Measures – Increasingly influential specialty behavioral health and functional measures.
- CAHPS® Surveys (Behavioral Health and Clinician & Group) – Frequently used to capture patient experience in managed care and integrated delivery models.
- CMMI Model-Specific Measure Sets – Applied in demonstrations and pilots testing integrated and value-based behavioral health models (e.g., health homes, ACO models).
- HRSA UDS Table 6B, Quality of Care Measures – Standard quality reporting for federally qualified health centers, including key behavioral health screening and follow-up measures.
Leveraging Medicaid Managed Care to Expand BHI
NASHP’s analyses of state approaches to behavioral health measures and managed care strategies to support behavioral health integration show how quality measures in Medicaid contracts (MCO) are being used to advance integration. Most states embed behavioral health measures into MCO contracts to track access, continuity, and coordination between physical and behavioral health services. Common examples include:
- Diabetes Care for People with Serious Mental Illness: Hemoglobin A1c (HbA1c) Poor Control (>9.0%)
- Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications
- Screening for Depression and Follow-Up Plan
Some states go further, tying select measures to plan payment or requiring quality improvement activities focused on BHI. With mandatory reporting on the BH Adult Core Set, states now have an opportunity to build on this federal foundation — adding outcome measures that are both feasible to track and meaningful across populations with mild, moderate, and complex conditions.
Meaningful Measures
Participants emphasized the importance of understanding outcomes that matter most to people receiving behavioral health care, regardless of setting. Person-centered measures track individual goals, follow-up, and progress, while quality-of-life (QOL) measures capture broader domains such as physical health, psychological well-being, social participation, and overall functioning.
Use of these measures can vary across systems based on population needs and the severity of mental illness or substance use conditions. For example, people with lived experience have identified priorities that may differ from traditional clinical measures (see Embedding Measures That Matter Into Mental Health Systems: A Lived Experience–Informed Measurement Framework for Serious Mental Illness). At the same time, functional status and patient-reported outcome measures offer shared points of alignment across systems and populations.
Commonly Referenced Measurement Sets
These commonly referenced quality-of-life and functional measures reflect growing emphasis across states and federal partners on outcomes that matter to individuals and enable payers to better evaluate impact, accountability, and value. These discussions highlighted both the opportunities and challenges of collecting person-centered and quality-of-life data, including differences across populations and settings, and ways to balance meaningful insights with feasibility.
Quality-of-Life Measures (General and Condition-Specific)
- WHOQOL-BREF (World Health Organization Quality of Life–BREF) – Assesses physical, psychological, social, and environmental domains.
- QLDS (Quality of Life in Depression Scale) – A condition-specific measure assessing the impact of depressive symptoms on daily functioning and well-being.
- PROMIS Global Health / Domain Scores – Standardized patient-reported outcomes that capture physical, mental, and social health.
Functional Assessments
- WHODAS 2.0 – Evaluates functioning across cognition, mobility, self-care, interpersonal interactions, life activities, and social participation, highlighting areas where integrated services improve daily functioning.
- DLA-20 (Daily Living Activities-20) – Assesses functioning across domains such as health practices, communication, relationships, and community living; used in some state and provider settings to support treatment planning and monitor functional improvement.
- CAFAS / PECFAS (Child and Adolescent Functional Assessment Scale / Preschool and Early Childhood Functional Assessment Scale) – Used to assess functioning in youth across domains such as school, home, community, and behavior toward others; supports care planning and tracking progress over time.
- Sheehan Disability Scale (SDS) – Measures functional impairment in work/school, social life, and family life, linking behavioral health care to real-world outcomes.
Aligning Behavioral Health Quality Measures Across Payors
States recognize that aligning behavioral health quality measures across Medicaid, commercial plans, and other public payers can reduce administrative burden for providers, improve data quality, and support system improvements. Alignment also strengthens the value proposition and provider capacity to participate in integrated care approaches and within value-based payment arrangements. Discussions focused on how alignment across payers can support integration of behavioral health into existing medical value-based payment (VBP) models.
Beyond measures, states are exploring alignment of billing codes, aligning definitions, shared dashboards, and attribution rules to enable equitable VBP incentives for behavioral health integration.
Examples of State Approaches to Alignment
- Washington State’s Common Measure Set (WSCMS) establishes a core of behavioral health and physical health measures across Medicaid and commercial plans. The set includes HEDIS measures with targeted state-developed indicators including follow-up after incarceration, opioid use disorders (OUD) treatment engagement, employment, housing stability, and homelessness. The state relies primarily on administrative and encounter data already reported by plans to track performance across regions, plans, and populations, while minimizing additional reporting burden.
- North Carolina’s Medicaid Managed Care Quality Strategy adopts a “gap-to-goal” benchmarking approach that emphasizes continuous improvement toward state targets.
- Massachusetts’ Quality Measure Alignment Taskforce is an effort that brings together public and private payers to develop a common set of quality measures for adoption across payers.
- California’s 2025 DHCS Comprehensive Quality Strategy (CQS) identifies and aligns quality measures used across Medi-Cal programs, supporting more consistent reporting, greater transparency, and alignment across delivery systems, while laying the groundwork for broader cross-payer alignment.
- West Virginia’s risk-based managed care program, Mountain Health Trust requires MCOs to enhance integrated physical and behavioral health care, embedding measure-alignment and integration expectations directly in contract language.
- New York State’s Quality Assurance Reporting Requirements apply across Medicaid, Child Health Plus, and commercial plans, enabling comparison to national benchmarks and supporting greater consistency in performance measurement across payers.
- Rhode Island created a statewide Data Ecosystem that integrates longitudinal health and human services data, supporting more consistent measurement and enabling cross-payer analysis of behavioral health outcomes and system performance.
- Colorado’s All-Payer Claims Database (CO-APCD) includes data from commercial plans, Medicare, and Medicaid, enabling more consistent performance tracking, benchmarking, and comparisons across payers.
Federal Momentum Creates Opportunities
CMS is accelerating efforts to standardize quality measurement across federal programs. States can build on these efforts to advance more standardized behavioral health quality measurement.
- The Core Quality Measure Collaborative is a broad-based coalition addressing cross-payer measure alignment through core sets of measures.
- The CMS Universal Foundation provides a streamlined set of high-priority quality measures used across federal programs including screening for depression and follow-up plan (672) and initiation and engagement of substance use disorder treatment (394).
- Specific CMS models advancing multi-payer alignment like the AHEAD Model.
Strategic Considerations for States Advancing BH Quality Measurement
Discussions surfaced a wide range of behavioral health quality measures currently in use. While states are drawing from many of the same tools, how those measures are selected, aligned, and applied varies. The table below includes some common measure types, examples, and gaps informed by participant input and a review of commonly referenced national sources.
Building on the measure types and gaps outlined above, discussions with states highlighted several strategic considerations to inform how quality measures are selected, aligned, and used to support behavioral health integration.
- Meaningfulness of Measures: Whether and how measures capture recovery, quality of life, and functional outcomes, alongside process-oriented measures.
- Measure Selection Strategy: Anchor priority measures in established clinical guidance, evidence-based practices, and nationally endorsed standards (e.g. USPSTF screening recommendations and widely used NCQA/HEDIS measures) with a focus on measures that can be applied across settings and behavioral health conditions.
- Feasibility and Administrative Burden: The extent to which measures can be implemented using existing data sources including claims, electronic health records (EHRs), clinical registries, or patient-reported outcomes, without adding undue reporting burden.
- Alignment Across Payers: Opportunities to align measures across Medicaid and commercial plans to support consistency and reduce duplication.
- Patient-Reported and Functional Outcomes: The role of patient-reported and functional measures alongside traditional quality metrics.
- Use of Measures for Improvement and Accountability: How measures are used to support quality improvement, population-level monitoring, and accountability, including their role in value-based payment.
- Data Infrastructure and Interoperability: Considerations related to data availability, integration, and gaps that affect measurement, analysis, and program decisions.
- Incentives: How program design and incentives influence participation, data completeness, and the usability of measures.
Conclusion
As BHI advances, quality measurement is shifting from a compliance exercise to a strategic lever — shaping priorities, informing payment, and reinforcing evidence-based care. This work underscores growing convergence around a core set of behavioral health measures and increasing opportunities to align measurement across programs and payers.
Participants also emphasized that measurement selection is only the starting point. Making measurement meaningful in practice requires timely and reliable data, stronger integration of claims and clinical information, and clear strategies for using results to drive improvement and accountability. NASHP will continue to engage states in how they are operationalizing quality measurement to advance behavioral health integration and support value-based payment.
Acknowledgments
NASHP would like to express our gratitude to West Health for its support and partnership with the Behavioral Health Integration Workgroup.
